Polypharmacy and Deprescribing in Fort Myers: What Your Medication List May Be Doing to You

More pills don't always mean better care — sometimes they mean more danger.

If you're over 60 and taking five or more prescription medications, you are not alone. According to the CDC, nearly 40% of older adults are in exactly that position. And while each prescription may have made sense when it was written, the combined effect of all those drugs together is a problem most patients — and frankly, most physicians — never fully address. That's what polypharmacy is, and it's one of the quieter dangers I see playing out in my patients every week. Deprescribing, the deliberate, physician-guided process of reducing or stopping unnecessary medications, is one of the most underused tools in medicine.

Why Polypharmacy Is More Dangerous Than It Looks

The human body metabolizes drugs through enzyme systems — primarily in the liver and kidneys. When you're taking two medications, the interaction risk is manageable. At five medications, the math gets complicated fast. At ten, you're in genuinely unpredictable territory. Research published in the British Journal of Clinical Pharmacology confirms that when multiple drugs share the same metabolic pathways or act on overlapping physiological systems, their combined effects can be amplified, blunted, or produce toxicities that no single drug would cause alone.

There's also what clinicians call a prescribing cascade. A patient starts a blood pressure medication. It causes ankle swelling. A new doctor sees the swelling and prescribes a diuretic. The diuretic causes gout. A rheumatologist prescribes an anti-inflammatory. The anti-inflammatory raises blood pressure. And so the spiral continues — each new prescription chasing a side effect of the last one.

A systematic review and meta-analysis published in JAMA Internal Medicine, examining 134,876 older adults, found that polypharmacy — defined as five or more medications — was associated with a 2.06-fold increased risk of falls.

Falls are not minor events in older adults. They are a leading cause of injury and death in this population, and the medications most likely to cause them — sedatives, antidepressants, antipsychotics, blood pressure drugs — are also among the most commonly prescribed.

The Real Cost of Polypharmacy

The Agency for Healthcare Research and Quality estimates that adverse drug events drive nearly 700,000 emergency department visits and 100,000 hospitalizations in the United States every year. That's not a rounding error. That's a public health crisis hiding in plain sight inside medicine cabinets across the country.

Here in Lee County, the stakes are especially high. Nearly 30% of Lee County residents are 65 or older — almost double the national average of 17%. That concentration of older adults makes polypharmacy a front-and-center issue for any physician practicing in this region.

What Deprescribing Actually Looks Like

Deprescribing is not reckless. It is not telling a patient to stop their heart medication because we feel like it. It is a systematic, evidence-informed review of every drug a patient takes — asking whether each one is still necessary, still effective, still appropriate for where that patient is in their health journey.

The American Geriatrics Society publishes the Beers Criteria, an updated list of medications that carry elevated risk in older adults due to side effects, limited efficacy, or dangerous interaction profiles. It's one of the frameworks we use to identify candidates for deprescribing. A Cochrane review of 67 studies found that structured deprescribing interventions can meaningfully reduce medication burden in older adults and decrease adverse drug reactions. Mayo Clinic data reinforce this, showing improvements in cognitive function, fall risk, and hospitalization rates when inappropriate medications are removed.

Important caveat: not every patient on multiple medications is over-medicated. Some people with complex chronic conditions genuinely need a robust regimen. The goal is never to minimize medications for its own sake — it's to make sure every drug on the list is earning its place.

What This Means for You

• Bring everything to your appointment. Every prescription, every over-the-counter drug, every supplement and herbal remedy. If we can't see the full picture, we can't assess it.

• Ask the hard question. For each medication: why am I still on this, is it still working, and what happens if we stop it?

• Never stop a medication on your own. Some drugs — particularly benzodiazepines, steroids, and certain antidepressants — require a careful taper to avoid rebound or withdrawal. Stopping abruptly can be dangerous.

• Request a dedicated medication review. Especially if you're on five or more drugs, or if you've recently developed new symptoms that feel like they came out of nowhere.

• Align your medications with your goals. A 45-year-old and an 82-year-old may have very different risk tolerances and treatment priorities. Your medication list should reflect yours.

The Bottom Line

Polypharmacy doesn't announce itself. It shows up as fatigue you can't explain, a fall that seemed to come from nowhere, a mind that isn't as sharp as it used to be. Deprescribing is how we push back — carefully, methodically, and always in partnership with the patient. At FMPW, we believe the best prescription is often the one you no longer need. That's not a philosophy. That's the evidence.

Schedule a consultation at Fort Myers Primary Care & Wellness. Call (239) 922-0909.

This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting any new wellness routine.

To your health,

Dr. Sabha